Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis

• Published in: European journal of cardio-thoracic surgery Vol. 50; no. 2; pp. 223 - 229
• Main Authors: Castrovinci, Sebastiano, Pacini, Davide, Di Marco, Luca, Berretta, Paolo, Cefarelli, Mariano, Murana, Giacomo, Alfonsi, Jacopo, Pantaleo, Antonio, Leone, Alessandro, Di Eusanio, Marco, Di Bartolomeo, Roberto
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 01.08.2016
• Subjects: Acute Disease; Aged; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Disease-Free Survival; Female; Follow-Up Studies; Hospital Mortality - trends; Humans; Italy - epidemiology; Male; Middle Aged; Propensity Score; Retrospective Studies; Survival Rate - trends; Time Factors; Treatment Outcome; Vascular Surgical Procedures - methods; Aortic root; Aortic dissection; Statistics; Propensity matching; Aortic operation
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezw038

OBJECTIVES Surgical management of the aortic root in type A acute aortic dissection (TAAAD) is controversial. This study compares short- and long-term outcomes of root replacement (RR) versus conservative root management (CR). METHODS Between 1999 and 2014, 296 patients with TAAAD were treated in our department. The mean age was 63.7 years. Of the total, 69% were male. Ten patients (3%) presented with Marfan syndrome or bicuspid aortic valve. RR was performed in 119 (40%) patients, whereas CR in 177 (60%). Pre- and intraoperative data were stratified according to root management, and treatment bias was addressed by propensity-score (PS) analysis. Independent predictors of hospital and long-term mortality and proximal aortic reoperation were identified using multivariable logistic and Cox regression models. RESULTS Using PS analysis, we obtain two groups of 82 patients. The matched cohort hospital mortality rate was 21% in the CR group and 26% in the RR group (P = 0.45). The unadjusted comparison showed no statistical difference in early and long-term mortality between the groups. This result was confirmed after standard logistic regression and propensity-adjusted logistic regression. Freedom from proximal aortic reintervention was higher in the RR group (at 7 years RR: 96 ± 3% vs CR: 80 ± 6%, log-rank P = 0.02) and remained high in the matched cohort of patients (at 7 years RR: 98 ± 2 vs CR: 86 ± 6, log-rank P = 0.06). CONCLUSIONS Conservative and aggressive root management in acute aortic dissection provided similar results for early and late mortality. Nevertheless, a more extensive root intervention appeared to be protective against aortic reintervention.